From the Guidelines
Fluid administration is recommended in patients with hypertensive emergency and acute kidney injury (AKI) to optimize renal perfusion. According to the KDIGO practice guideline on acute kidney injury, isotonic crystalloids, such as 0.9% saline or lactated Ringer's solution, are suggested for expansion of intravascular volume in patients at risk for AKI or with AKI 1. A bolus of 500-1000 mL of crystalloids may be given over 30 minutes to 1 hour, with subsequent infusion rates titrated to maintain a urine output of at least 0.5 mL/kg/hour. The European Heart Journal also emphasizes the importance of controlled blood pressure reduction to prevent further hypertensive damage, but does not provide specific guidance on fluid administration in patients with AKI 1. However, based on the KDIGO guidelines, crystalloids are preferred over colloids for fluid resuscitation in patients with AKI 1.
- Key considerations for fluid administration include:
- Using isotonic crystalloids, such as 0.9% saline or lactated Ringer's solution
- Avoiding colloids, such as albumin or starches, due to lack of evidence supporting their superiority and potential risks
- Titration of infusion rates to maintain optimal urine output and renal perfusion
- Monitoring for signs of fluid overload and adjusting fluid administration accordingly It is essential to note that the choice of fluid and the volume of administration should be individualized based on the patient's clinical context and response to treatment 1.
From the Research
Hypertensive Emergency and Acute Kidney Injury (AKI)
In patients with hypertensive emergency and acute kidney injury (AKI), the management approach is crucial to prevent further organ damage.
- The provided studies do not directly address the use of fluid administration in patients with hypertensive emergency and AKI 2, 3, 4, 5, 6.
- However, it is essential to note that the management of hypertensive emergencies involves careful blood pressure control to prevent ongoing organ damage, and the use of parenteral medications is often recommended 3, 5.
- The goal of treatment is to balance the positive effects of lowering blood pressure with the potential for negative effects of organ hypoperfusion in patients with altered autoregulatory mechanisms 6.
- In general, the management of hypertensive emergencies requires a tailored approach, considering the specific situation and the type and extent of organ damage 2, 4.
Key Considerations
- The distinction between hypertensive emergency and urgency is crucial, as it guides the management approach 3, 5.
- In patients with hypertensive emergency, blood pressure control should be attained as expeditiously as possible to prevent ongoing organ damage 5.
- Long-term control of blood pressure is essential to prevent recurrent hypertensive emergencies and improve overall prognosis 4, 6.